Klintmalm Goran B, Saab Sammy, Hong Johnny C, Nashan Björn
Department of Transplant Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA.
Clin Transplant. 2014 Jun;28(6):635-48. doi: 10.1111/ctr.12357. Epub 2014 Apr 21.
Post-transplant malignancies, which occur either de novo or as cancer recurrences, are due to chronic exposure to immunosuppressive agents and are often more aggressive than those that develop in the non-transplant setting. Mammalian target of rapamycin (mTOR) inhibitors have antitumor and immunosuppressive effects. The dual effects of this class of agents may provide adequate immunosuppression to prevent organ rejection while simultaneously reducing the risk of post-transplant malignancy. mTOR inhibitors have become established approved agents for treating renal cell carcinoma and other cancers and, as reviewed herein, accumulating experience among organ transplant recipients collectively points toward a potential to prevent the development of de novo malignancies of various types in the post-transplant period. To date, most research efforts surrounding mTOR inhibitors and cancer control in the transplant population have been in the area of skin cancer prevention, but there have also been interesting observations regarding regression of post-transplant Kaposi's sarcoma and post-transplantation lymphoproliferative disorder that warrant further study.
移植后恶性肿瘤，无论是新发还是癌症复发，都是由于长期接触免疫抑制剂所致，并且通常比非移植情况下发生的恶性肿瘤更具侵袭性。哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂具有抗肿瘤和免疫抑制作用。这类药物的双重作用可能提供足够的免疫抑制以防止器官排斥，同时降低移植后恶性肿瘤的风险。mTOR抑制剂已成为治疗肾细胞癌和其他癌症的既定批准药物，如本文所述，器官移植受者中积累的经验共同表明其具有预防移植后新发各种类型恶性肿瘤的潜力。迄今为止，围绕mTOR抑制剂与移植人群癌症控制的大多数研究工作都集中在皮肤癌预防领域，但也有关于移植后卡波西肉瘤和移植后淋巴细胞增殖性疾病消退的有趣观察结果，值得进一步研究。
